Pharm Care Endocrine Disorders Thyroid

Front 1

what are the 3 major roles of the thyroid hormone?

Back 1

stimulate basal metabolic rate
protein, carb, & lipid metabolism
normal growth & development

Front 2

thyroid hormone is synthesized from?

Back 2

iodine and tyrosine

Front 3

what are the 3 proteins that can bind thyroid hormone?

Back 3

TBG, TBPA, albumin

Front 4

how is T3 synthesized?

Back 4

20-25% biosynthesized
the rest is made from converted T4

Front 5

which is more potent, T3 or T4?

Back 5

T3

Front 6

what percentage of T3 is free? T4?

Back 6

FT3 = 0.2%
FT4 = 0.02%

Front 7

what controls the release of thyroid hormones?

Back 7

TSH
thyroid stimulating hormone

Front 8

what controls the release of TSH?

Back 8

TRH
thryoid releasing hormone

Front 9

what is the negative feedback system that controls TSH & TRH

Back 9

intracellular T4 and T3

Front 10

what has a negative effect on thyroid production?

Back 10

intrathyroidal iodide

Front 11

how are the concentrations of TSH and FT4 related?

Back 11

they are logarithmic (a 50% reduction in FT4 leads to a 50 fold incr of TSH)

Front 12

what is hypothyroidism?

Back 12

a decr in T4 and T3

Front 13

what is thyrotoxicosis?

Back 13

a incr in T4 and T3

Front 14

what is primary hypothyroidism?

Back 14

related to the thyroid gland itself
deficiency or excess of iodide

Front 15

what is secondary hypothyroidism?

Back 15

related to the pituitary
reduced TSH (hypopituitarism)

Front 16

what is tertiary hypothyroidism?

Back 16

reduced TRH
hypothalamic dysfunction

Front 17

thyrotoxicosis: overproduction caused by

Back 17

graves
carcinomas
TSH secreting adenomas (benign tumor)

Front 18

thyrotoxicosis: leading thyroid hormone destruction caused by

Back 18

sub acute thyroiditis
radiation

Front 19

what is subacute thyroiditis?

Back 19

inflammation of the thyroid gland that usually follows an upper respiratory infection and then subsides

Front 20

drugs that can cause thyrotoxicosis

Back 20

excess thyroid replacement
iodinated radiocontrast agents

Front 21

what are the s/s of thyrotoxicosis?

Back 21

cardiac arrhythmias
nervousness
sweating
goiter

Front 22

what are the s/s of hypothyroidism

Back 22

sensitivity to cold
depression
weight gain
constipation

Front 23

what are the 4 tests for diagnosing and monitoring thyroid function?

Back 23

concentration of hormones
intrinsic thyroid gland function
integrity of axis
antibodies to thyroid gland

Front 24

for the concentration of hormones test, which hormones are looked at?

Back 24

free T4
total serum T4
serum T3 resin uptake
free T4 index
total serum T3

Front 25

which thyroid hormone concentration is the best measure of thyrometabolic status?

Back 25

free T4

Front 26

why is free T4 difficult to measure?

Back 26

because it is in such a low concentration

Front 27

concentration test using FT4 is used when

Back 27

there are alterations in T4 binding globulins
nonthyroidal illness confounds interpretation

Front 28

FT4 reference range

Back 28

0.8 to 1.5 ng/dL

Front 29

what is the diagnosis if you have lowered FT4 and incr TSH

Back 29

primary hypothyroidism

Front 30

what is the diagnosis if you have incr FT4 and decr TSH?

Back 30

non pituitary hyperthyroidism (primary)

Front 31

if you have low TSH and low FT4, you should treat with?

Back 31

T3

Front 32

what can cause abnormal lab results in a FT4 concentration test?

Back 32

severe T4 binding alterations

Front 33

total serum T4 concentration is used as?

Back 33

a standard screening test (widely available & quick turnaround time)

Front 34

reference range for total serum T4

Back 34

4 to 12 ug/dL

Front 35

incr in total T4 may indicate

Back 35

hyperthyroidism
incr thyroid binding proteins
non-thyroid illness

Front 36

decr in total T4 may indicate

Back 36

hypothyroidism
decr in thyroid binding proteins
non thyroid illness (euthyroid sick syndrome)

Front 37

how is the total serum T4 test conducted?

Back 37

radio immunoassay method
the specimen is serum

Front 38

what can cause abnormal incr in serum T4 lab results

Back 38

incr TT4 in minor illness (esp elderly)
transient decr in TSH
incr TT4 in psychiatric patients

Front 39

what can cause an abnormal decr in total serum T4 lab results

Back 39

decr thyroid binding proteins (neoplastic disorders, DM, burns, liver disease, renal disease, trauma, prolonged infection)

Front 40

drugs that can incr TBP

Back 40

heroin
estrogen
methadone

Front 41

drugs that can decr TBP

Back 41

salicyates
glucocortoids (high dose)
furosemide (high dose)

Front 42

drugs that can incr TT4 and FT4

Back 42

iopdate
iodides
propanolol

Front 43

drugs that can decr TT4 and FT4

Back 43

lithium carbonate
sulponamides
antacids

Front 44

what data does serum T3 resin uptake test give?

Back 44

indirect estimate of number of binding sites
can verify clinical significance of measured TT4 & TT3

Front 45

what does the serum T3 resin uptake test differentiate between?

Back 45

low T3 secondary to nontyroidal illness from ture hypothyroidism

Front 46

reference range for serum T3 resin uptake

Back 46

25-34%

Front 47

serum T3 resin uptake results for hypothyroidism

Back 47

low TT3 and FT3
normal TBP
low T*3 uptake (33%)

Front 48

serum T3 resin uptake results for hyperthyroidism

Back 48

low TT3 and FT3
low TBP (low # binding sites)
incr T*3 uptake (66%)

Front 49

what can cause abnormal lab results in the serum T3 resin uptake test?

Back 49

all disease staes & drugs that alter TBG
radioactive substances taken by patients

Front 50

what is the serum T3 resin uptake test used to calculate

Back 50

free thyroxine index (FTI)

Front 51

what is the rationale behind the free thyroxine index?

Back 51

adjusts for effects of TBP alterations

Front 52

FTI referance range

Back 52

1.0-4.0units

Front 53

calculation for FTI

Back 53

FTI = TT4(mg/dL) X T3 resin uptake (%)